Longer lives are one of the greatest achievements in medicine. Yet we see a diminished quality of life for many older adults, especially women, due to social and health inequities institutionalized in health care.
A rising aging population is a reality across the world, with older women comprising the majority of this population in many countries. The impact of COVID-19 on older adults remains a relentless reminder of why we all need to care about their health and well-being. We should both reflect on and leverage this as a rare and important opportunity to usher in change that improves the lives of older men and women everywhere.
This is especially true for older women. We know that there are differences in aging between men and women. Women live longer. They are more likely to suffer from chronic conditions, take more medications as a result and are more at risk from harmful drug events. Yet, until the 1990s, women were not required to be included in National Institute of Health (NIH)-funded studies. Up until 2019, older adults were not required to be included in NIH-funded studies. To this day, the collection and use of data disaggregated by sex and age are lagging on many fronts, causing major disparities in recognizing and understanding the needs of older women and our ability to create tailored interventions for them.
This alone should make researchers, health-care providers and decision-makers rethink the trajectory of public health and recognize the gaps that remain unaddressed, especially as they relate to older women.
It is important to look at issues with respect to longevity for men, but it is equally important to look at specific ways to improve quality of life for older women. Our goal should not just be to live longer, but to support long lives with a raised standard of health, comfort and well-being.
As a first step, we need to ask ourselves: Why don’t we think about the unique needs of women as a default when it comes to healthy aging? What is causing the lack of awareness around the health and well-being needs of older women? How do inequities in social and health-care systems negatively affect health outcomes for women? How do we de-institutionalize these inequities?
To this day, the collection and use of data disaggregated by sex and age are lagging on many fronts.
Older women face the heavy impact of gendered ageism, a form of discrimination based on age and sex that is embedded in our social, cultural and health-care systems. Gendered ageism is still not fully understood and addressed in health care, leading it to spread through our institutions unchecked.
Throughout the COVID-19 pandemic, we have seen the devastation in congregate care settings such as long-term care (LTC) homes, but considerations for older women have been missed not just in the news cycle, but also in research data and literature, even though they make up the majority of the LTC population. We know that LTC has a strong gender dimension. We need to take this recognition a step further and create solutions related to the design of LTC homes.
Due to a lifetime of discrimination faced by women with respect to socio-economic policy and practices – through the gender pay gap, maternity leave, less pension payments and unpaid work – older women face a higher poverty gap than older men, restricting their options to obtain the best care and support possible.
Being connected to society, family and friends improves well-being for all of us, yet many older women continue to be lonely because of major life transitions like retirement, widowhood and chronic conditions. Since they live longer than men, loneliness is often a major issue. Most older women live in the community and make efforts to continue to live independently as much as possible. However, their environments often do not have the infrastructure to allow them to participate in their communities in a meaningful way.
We need to elevate older women as a distinct population and recognize that if we continue to prescribe and implement generic interventions and solutions that do not suit them, our actions will cause more harm than good. Interventions and initiatives tailored to their needs will enable them to live better and healthier lives.
The WHO and the UN, along with many governments and industries worldwide, have created plans and strategies for healthy aging. These strategies are not specifically aimed at women. A gender lens and an action plan for older women would be a crucial foundation for these multi-sectoral initiatives and strategies aiming to promote healthy aging.
We need to be informed by the voices of older women to first raise awareness of the importance of considering and addressing their health and well-being needs based on science.
We need to ensure that our strategies are supported by evidence based on data disaggregated by sex and age. It is crucial that we normalize the use of disaggregated data as a default. Decision-makers need to understand the value of using disaggregated data to inform their decisions. Embedding the use of these data through policy and practice will both educate and help decision-makers close existing gaps for older women.
Our health-care providers need to understand the importance of using tailored interventions and pathways to support the health and well-being of older women. This responsibility should not just fall on geriatricians. There is a high likelihood of primary care physicians, nurses, social workers and other clinicians engaging with older women since there are not enough geriatricians in North America to serve the older adult population. We need to raise awareness among all health-care professionals so they can ask the right questions and provide proper care.
These steps need a concerted effort across governments, researchers, health-care organizations and pertinent sectors. We all have a role to play in strengthening our efforts to ensure that we change our trajectory and promote gender equity in health care. The unique health and well-being needs of older women must be recognized and addressed.